AL approves Medicaid waiver for Dupree
MOBILE, AL, Feb. 11, 2003 -- Late yesterday, HHS Secretary Tommy G. Thompson announced the approval of a new Medicaid waiver in Alabama to provide services "to certain Medicaid-eligible individuals" which "will assure continued support for people who might otherwise lose their services simply because they turn 21." (Read HHS press release.) Attorneys for Nick Dupree had filed for an junction to keep the 20-year-old Mobile man out of an Alabama nursing home; a hearing is scheduled for today. But the real impetus behind the action was pursuit of the story by NPR's Joe Shapiro. Yesterday Shapiro reported on Dupree's fight on All Things Considered."
Listen to NPR's All Things Considered with Joe Shapiro's report on Dupree's nursing-home battle.
Read story in Mobile Register.
Nursing home looms for Dupree, 20, unless policy changes
MOBILE, AL, Feb.3, 2003 -- Nick Dupree will be forced against his will into a nursing home by the state of Alabama after he turns 21 on February 23rd. That's the only option open to him under the state's Medicaid rules.
As Pres. Bush insists to advocates that he is working to help states "'re-balance' their long term care systems so that there are more cost-effective choices between institutional and community options" as part of his much-vaunted "New Freedom Initiative," activists are asking him to act as though he takes the Initiative seriously.
Dupree has been pressing a campaign for several years to draw attention to Alabama's archaic, pro-nursing home Medicaid rules -- and to push for changing federal Medicaid law to let "money follow the person" to live in the community, as the bill known as the Medicaid Community Attendant Services and Supports Act (MiCASSA) would require. Dupree has a personal reason for pushing for change. He doesn't want to be forced to live in a nursing home.
Yet as his 21st birthday approaches, Dupree is can see the nursing home door. Nothing has changed. "This is the "New Freedom Initiative?"asks activist Barb Knowlen.
Dupree is currently receiving in-home assistance from Medicaid's Early and Periodic Screening, Diagnostic, and Treatment Program, which, as Dupree writes on the website iCan.com, "is the only long-term home care program providing enough care hours to avoid institutionalization in Alabama and often in other states like Georgia, Mississippi and Louisiana, where they have some of the lowest average incomes, poorest state budgets and lowest Medicaid budgets in the country." The EPSDT program is required under Medicaid, but it was designed as aid for children, and its eligibility cutoff is 21. Alabama offers no personal assistance program. "The only programs available for adults with physical disabilities here are for respite care 12 hours a week. "
A recent press release from the U.S. Dept. of Health and Human Services announced a "new $1.75 billion, five-year program to help Americans with disabilities transition from nursing homes or other institutions to living in the community, which it reported would be part of the budget Bush would be unveiling in Feb. The administration says it's just one of several new efforts in the FY 2004 budget under Bush's New Freedom Initiative. The money "would assist states in developing and implementing a strategy to 're-balance' their long term care systems so that there are more cost-effective choices between institutional and community options," says HHS. They can In "pay the full cost of home and community-based waiver services for one year, after which the participating states would agree to continue care at the regular Medicaid matching rate."
Despite HHS's rhetoric, the Administration has apparently made no move to assist Dupree or to advise Alabama Medicaid officials about the ADA's "integration mandate" which, upheld in the 1999 Olmstead Supreme Court decision, said that states should provide services in the "most integrated setting."
Two years ago, Dupree started a website -- www.nickscrusade.com -- which has gotten some attention. But an Alabama bill from Dupree advocates was opposed by nursing home interests and failed to pass.
This should be the kind of story about a potential loss of freedom that gets massive national news coverage -- witness Elian Gonzales. But there's been no national news coverage of Dupree's impending loss of freedom.
"The other day in announcing his position on affirmative action, the President said that "America's long experience with segregation (is) behind us' -- but nothing could be further from the truth," says former HHS Deputy Assistant Secretary for Disability, Aging and Long Term Care Policy, Bob Williams, who has set up the group Advancing Independence: Modernizing Medicare and Medicaid -- or AIMM (http://www.aimmm.org).
AIMMM urges advocates to contact Ala. Gov. Bob Riley. "Insist that he take immediate action as the new Governor of Alabama to reverse his state's policy of forced institutionalization." (Riley's office contact info is: Alabama State Capitol, 600 Dexter Ave., Montgomery, AL 36130-2751; ph. 334-242-7100.) They also urge advocates to fax letters to John Wodatch, Chief of Disability Rights Section, U.S. Dept. of Justice, at 202-307-1198, and to fax letters to HHS Sec. Tommy Thompson (fax no. 202-690-7203) to write the governor to say the state's Medicaid practice "will not be tolerated and must be reversed immediately."
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